Abstract：
OBJECTIVE: Post-cholecystectomy biliary strictures can be treated surgically or nonsurgically. Although endoscopic or percutaneous treatments are the preferred approaches, these methods are not feasible in cases in which complete stricture occlusion prevents the successful passage of a guidewire. The utility of magnetic compression anastomosis (MCA) in patients with post-cholecystectomy complete biliary obstruction that cannot be treated conventionally was evaluated.
METHODS: MCA was performed in 10 patients with post-cholecystectomy biliary strictures that did not resolve with conventional endoscopic or percutaneous treatment. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and another was advanced via ERCP of the common bile duct. After magnet approximation and recanalization, a fully covered self-expandable metal stent (FCSEMS) was placed for 3 months and then replaced for an additional 3 months. Stricture resolution was evaluated after FCSEMS removal.
RESULTS: Among the 10 patients who underwent MCA for post-cholecystectomy biliary stricture, the biliary injury was Strasberg type B in 2, type C in 3, and type E in 5. Recanalization was successful in all patients (technical success rate, 100%). The mean follow-up period after recanalization was 50.2 months (range, 13.2-116.8 months). Partial restenosis after MCA occurred in 2 patients at 24.1 and 1.6 months after stent removal. ERCP with FCSEMS placement resolved the recurrent stenosis in both patients.
CONCLUSIONS: MCA is a useful nonsurgical alternative treatment for complete biliary obstruction after cholecystectomy that cannot be resolved by use of conventional methods.
METHODS: MCA was performed in 10 patients with post-cholecystectomy biliary strictures that did not resolve with conventional endoscopic or percutaneous treatment. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and another was advanced via ERCP of the common bile duct. After magnet approximation and recanalization, a fully covered self-expandable metal stent (FCSEMS) was placed for 3 months and then replaced for an additional 3 months. Stricture resolution was evaluated after FCSEMS removal.
RESULTS: Among the 10 patients who underwent MCA for post-cholecystectomy biliary stricture, the biliary injury was Strasberg type B in 2, type C in 3, and type E in 5. Recanalization was successful in all patients (technical success rate, 100%). The mean follow-up period after recanalization was 50.2 months (range, 13.2-116.8 months). Partial restenosis after MCA occurred in 2 patients at 24.1 and 1.6 months after stent removal. ERCP with FCSEMS placement resolved the recurrent stenosis in both patients.
CONCLUSIONS: MCA is a useful nonsurgical alternative treatment for complete biliary obstruction after cholecystectomy that cannot be resolved by use of conventional methods.
摘要：
目的：胆囊切除术后胆管狭窄可手术或非手术治疗。尽管内窥镜或经皮治疗是首选方法，在完全狭窄闭塞阻碍导丝成功通过的情况下,这些方法是不可行的.评估了无法常规治疗的胆囊切除术后完全性胆道梗阻患者中磁压吻合（MCA）的实用性。
方法：对10例胆囊切除术后胆道狭窄的患者进行了MCA，这些患者通过常规内镜或经皮治疗无法解决。一块磁铁通过经皮肝穿刺胆道引流道，另一种方法是通过内镜逆行胰胆管造影（ERCP）进行胆总管造影。在磁铁近似和重新扫描后，我们放置全覆膜自膨式金属支架(FCSEMS)3个月,然后再更换3个月.在FCSEMS移除后评估狭窄度。
结果：在10例因胆囊切除术后胆管狭窄而接受MCA的患者中，胆道损伤为StrasbergB型2例，C型3例，E型5例。所有患者的再通均成功（技术成功率为100％）。再通后平均随访时间为50.2个月（范围13.2-116.8个月）。2例患者在取出支架后24.1和1.6个月发生MCA术后部分再狭窄。FCSEMS放置的ERCP解决了两名患者的复发性狭窄。
结论：对于常规方法无法解决的胆囊切除术后完全性胆道梗阻，MCA是一种有用的非手术治疗方法。
方法：对10例胆囊切除术后胆道狭窄的患者进行了MCA，这些患者通过常规内镜或经皮治疗无法解决。一块磁铁通过经皮肝穿刺胆道引流道，另一种方法是通过内镜逆行胰胆管造影（ERCP）进行胆总管造影。在磁铁近似和重新扫描后，我们放置全覆膜自膨式金属支架(FCSEMS)3个月,然后再更换3个月.在FCSEMS移除后评估狭窄度。
结果：在10例因胆囊切除术后胆管狭窄而接受MCA的患者中，胆道损伤为StrasbergB型2例，C型3例，E型5例。所有患者的再通均成功（技术成功率为100％）。再通后平均随访时间为50.2个月（范围13.2-116.8个月）。2例患者在取出支架后24.1和1.6个月发生MCA术后部分再狭窄。FCSEMS放置的ERCP解决了两名患者的复发性狭窄。
结论：对于常规方法无法解决的胆囊切除术后完全性胆道梗阻，MCA是一种有用的非手术治疗方法。
